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EXECUTIVE SUMMARY

I
ECAP
(2004)
II
CCACO
(2011)
III
SOMOS/ACP
(DSRIP, 2014)
IV
INNOVATOR
(VBP, 2018)
FUTURE
PATH OF
SUCCESS
I
ECAP
(2004)
II
CCACO
(2011)
III
SOMOS/ACP
(DSRIP, 2014)
IV
INNOVATOR
(VBP, 2018)
FUTURE
PATH OF
SUCCESS

In 2004, a group of energetic and enthusiastic physicians were like-minded in their goals to increase the quality of care to patients and formed the Eastern Chinese American Physicians IPA, Inc., a successful independent physician association based in New York City. Since then, this core group of dedicated physicians has continued to demonstrate a track record of success by leading the way to transform healthcare in their communities by establishing other profitable physician-led and operated organizations with their strong leadership and management skills, experience in hospital administration and HMO knowledge. In 2011, the Chinese Community Accountable Care Organization, Inc. was formed and has saved CMS $16 million in healthcare costs. In 2014, a strategic alliance was created with other physician groups to form the largest as well as only physician led Performing Provider System (PPS) in the New York State's Delivery System Reform Incentive Payment (DSRIP) program. As the healthcare landscape continues to transition from fee for service to performance and quality-based care, these pioneering physicians will participate in the NY State Innovator Program that rewards early adopters of value based payments. Undoubtedly, these physician leaders will continue to be at the forefront of transforming healthcare.

A summary and highlights of achievements for each organization is listed below.

I.  EASTERN CHINESE AMERICAN PHYSICIANS IPA, INC. (ECAP)

The Eastern Chinese American Physicians IPA, Inc. ("ECAP") (www.ecapipa.org) is a physician owned and operated independent practice association established in 2004 that is comprised of more than 275 physicians, the majority of which have been in practicing medicine for over 10 years, that serve an estimated 190,000 Medicare and Medicaid beneficiaries within the Chinese communities throughout New York City in the boroughs of Manhattan, Brooklyn and Queens. ECAP's physician network is comprised of primary care physicians as well as specialist physicians in all areas of medicine to provide a full spectrum of care to beneficiaries. ECAP providers are uniquely able to provide culturally competent and language specific care to patients in this underserved community that may otherwise have limited access to healthcare. ECAP's is led by a dedicated group of 9 member Board of Directors who are recognized physicians in the community as key thought leaders who keenly understand the ever-changing landscape of healthcare and have the vision to participate in transforming and improving healthcare.

HIGHLIGHTS OF ECAP's ACHIEVEMENTS:

  • ECAP participates in 4 Major HMO contracts with fee for service and capitation.

  • ECAP receives over $1,600,000 in shared savings and incentives from insurance companies, each year.

  • ECAP participates in VBP programs (Level 1) with various payors (Wellcare and VNS).

  • ECAP consistently ranks 2nd in performance metrics and shared savings incentives with a large, well-recognized HMO.

  • ECAP functions using lean principles and operates with a low overhead and administrative expense of < 25%.

  • ECAP Routinely achieves an average Medical Loss Ratio (MLR) / Medical Benefits Ratio of 72%.

  • ECAP's leadership team and management have great experience and successfully lowered the MLR and reduced medical utilization. For example, ECAP experienced a dramatic reduction from 125% to 75%-89% over a 6 month period after receiving data from Health Plans.

  • ECAP provides high quality medical care at a low cost by providing healthcare to beneficiaries compared to the average expenditures of all NYC beneficiaries. The average ECAP expenditures represent only:

    • 55% of hospital in-patient visits ($145.00 ECAP vs. $265.60 NYC) per member per month

    • 39% of private practice out-patient visits ($23.67 ECAP vs. $60.73 NYC) per member per month

    • 31% of emergency room visits ($3.79 ECAP vs. $12.29 NYC) per member per month.

II.  CHINESE COMMUNITY ACCOUNTABLE CARE ORGANIZATION, INC. (CCACO)

The Chinese Community Accountable Care Organization, Inc. ("CCACO") (www.ccaco.org) is a physician owned and operated accountable care organization formed in 2011 that is comprised of more than 200 physicians, the majority of which have been in practice for over 10 years practice, that serve approximately 12,000 Medicare beneficiaries within the Chinese communities throughout New York City in the boroughs of Manhattan, Brooklyn and Queens. CCACO has over 100 primary care physicians as well as specialist physicians in the areas of cardiology, gastroenterology, otolaryngology, endocrinology, gynecology/obstetrics, pediatrics, etc. CCACO is well equipped to coordinate and provide culturally competent care to patients in this unique community. The Board of Directors who lead and guide the organization are 11 esteemed physicians, who are each recognized within the community as experts in their particular area of practice.

HIGHLIGHTS OF CCACO'S ACHIEVEMENTS:

  • The FIRST Chinese ACO in the United States awarded by the Medicare Shared Savings Program.

  • The FIRST ACO approved to operate in NYC in 2012.

  • Early on, CCACO was recognized as a leader in reducing health care costs - 1 of 7 nationally recognized ACOs out of 114 ACOs in 2012 to receive an interim share savings payment in 2013.

  • CCACO continues to demonstrate a strong track record of achieving shared savings. CCACO saved CMS $11 million in 2015 (11% of total expenditures) and $7 million in 2016 (7% of total expenditures) in medical costs.

  • CCACO was 1 of only 4 ACOs to receive shared savings incentive payments in 2 consecutive years in 2015 and 2016.

  • In 2016, CCACO ranked 3rd in earned shared savings payments among New York's 32 ACOs. Only 5 ACOs received shared savings payments.

  • CCACO consistently excels in performance metrics and achieved an overall quality score of 89.3% for 2016.

  • CCACO was awarded a prestigious grant from the New York State Health Foundation to enable nearly 70 CCACO Physicians, who practice in the Chinese Community to successfully achieve recognition by the National Committee of Quality Assurance (NCQA) Diabetes Recognition Program as Diabetes Providers of Excellence.

  • CCACO currently has over 100 practices with Level 3 certification for NCQA's Patient Centered Medical Home (PCMH) model, the gold standard for PCP-focused primary care model. CCACO continues to assist physicians to maintain and transform their practices to the current PCMH standards, as the foundation for an accountable care organization.

III.  ADVOCATE COMMUNITY PROVIDERS, INC.

The Advocate Community Providers, Inc. ("ACP", n/k/a SOMOS Community Care) (www.somoscommunitycare.org) is a physician-led Performing Provider System (PPS), formed in 2014 by the joint leadership of the ECAP and CCACO leadership and the Corinthian Medical IPA, Excelsior IPA and Balance ACO leadership, to participate in New York State's Delivery System Reform Incentive Payment (DSRIP) program, which allocated over $6.4 billion in grant awards to transform the delivery of healthcare for Medicaid beneficiaries and reduce avoidable hospital admissions by 25% in New York. Recognizing their uniquely positioned ability to play a key role in reforming healthcare for Medicaid Beneficiaries, the leadership of the Asian and Hispanic physician communities throughout New York City came together to meaningfully impact and improve healthcare by creating a clinically integrated delivery system and network to manage the full spectrum of a patient's healthcare needs. The Governing Board that leads and guides the organization includes esteemed physicians, from ECAP and CCACO, who are each recognized within the community as experts in their area of practice.

HIGHLIGHTS OF ACP'S ACHIEVEMENTS:

  • ACP is one of 25 PPS and the only physician-led PPS to participate in the New York State DSRIP Program.

  • ACP awarded over $700 million during the 5-year DSRIP program.

  • ACP has distributed over $65 million in incentive payments for achieving "pay for performance" measures and metrics to its physicians and partners in the community.

  • ACP repeatedly achieves targets measures for reporting and performance (98 percentile).

  • ACP PPS is a physician-led organization that represents a network of approximately 2,000 community physicians and over 950 partner organizations serving an approximately 650,000 Medicaid beneficiaries that will provide coordinated care to New York City patients, most in at-risk, underserved communities.

  • ACP PPS represents several Independent Physician Associations (IPAs), 2 Medicare Shared Savings Program Accountable Care Organizations (ACOs) and Health Homes. Each organization has demonstrated success in providing coordinated patient-centered care while controlling cost and improving quality as well as established track records for efficiently managing population health.

IV.  INNOVATOR PROGRAM

The success of ECAP, CCACO and ACP's value based programs and pay for performance incentives established the foundation for the formation of a "super IPA." ECAP is a key component of the super IPA, SOMOS IPA, an alliance with other successful IPAs that will participate in the New York Value Based Payment Innovator Program. The Innovator Program encourages and rewards early adopters of value based payment arrangements, such as ECAP, that have attained a maturity level and proven track record of success in value based payment contracting for TCTP and Subpopulations.

HIGHLIGHTS OF THE NY VBP INNOVATOR PROGRAM:

  • Anticipated Innovator Program to start in 2018 (Q4).

  • SOMOS IPA, including ECAP, will participate in "Total Care for Total Population" (TCTP) and "Subpopulation" value-based arrangements (Level 2 and Level 3) that will pay up to 95% of the total dollars traditionally paid from New York State to insurance payers.

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